The Woman with the Binder

There is a woman in Winnipeg whose principal work for several years has been the work of deciding. She keeps a binder. In it are the letters from three psychiatrists, the names of the medications she has tried and the months each one took from her, the dates of two hospital stays, and a page in her own handwriting, revised many times, explaining what her life is like to someone who has never had to live it. She assembled that binder because the Government of Canada told her that in March 2027 a person whose sole underlying condition is a mental illness could ask for medical assistance in dying. Now Ottawa has suspended the expansion, with no new date. The binder is still on her kitchen table. The government has given her no instruction about what to do with it.

I do not know whether she should die. I want to say that plainly, because the people who pressed for this suspension are not fools, and their argument deserves its full weight. Psychiatrists cannot reliably say when a mental illness is beyond remedy. The wish to die is often a symptom of the illness rather than a verdict on it. People do recover after years that looked hopeless from inside. And there is something grotesque about a country in which a man can wait many months for a psychiatric appointment but might, under the expanded law, be assessed for death on a firmer timetable. If the state is going to fail someone, it should not fail them in that order. That is the strongest case for the suspension, and it is a serious one.

Look at what that case actually rests on, though. It rests on the waiting list. It rests on the claim that a suffering person in Canada cannot get timely care, so we cannot trust that her request is a free choice rather than the despair of someone left standing in a corridor. But the corridor was built. Canadian provinces decide how medical services are paid for, which treatments are covered, and how much room is left for anyone to provide care outside the public plan. The scarcity of psychiatrists’ hours did not arrive like weather. It is the result of a system in which the energy of doctors, clinics, and patients flows through channels a ministry has dug. The argument for suspension amounts to this: the state has rationed her care so badly that it cannot now trust her judgment, and therefore the state must hold one more door shut. The answer to a failed monopoly is offered as a wider monopoly.

Then there is the word indefinitely, which deserves more attention than it has received, because a refusal is something a person can push against, appeal, argue with, or accept and turn away from, and a date is something a person can plan toward, prepare her family for, or quietly decide to let pass, but an indefinite suspension is neither, and what it does to a person is convert her from someone making a decision into someone awaiting one, which is a different condition entirely, and a worse one for anyone whose illness already feeds on waiting.

When my mother’s people settled on the prairie, the families who did worst were often not the unlucky ones. They were the ones waiting to learn where the railroad surveyors would put the town. They would not build until they knew, and they would not plant until they had built, and some of them spent a whole season with their wagons half-unpacked, their strength going into rumour and speculation instead of sod. The railroad was a private company with a schedule it kept to itself, and it did real damage. Ottawa has made itself the surveyor here, and it has declined to say when it will return to the field.

The decision about this woman’s life sits closest to three places: her own mind, her doctors’ long knowledge of her case, and the family who sits with her through the bad winters. None of those places is a committee room. Everything that would actually change her situation lies outside the government’s reach: a psychiatrist with an open afternoon, a treatment her plan does not cover, a clinic that could exist if someone were permitted to open it. Those are what the suspension claims to be protecting her for, and they are exactly what the system rations.

So the energy that might have gone into her treatment, or into her family’s patience, or into her own slow reckoning, goes instead into a binder whose final tab she has now labelled, in neat capitals, PENDING.